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Gluten-free food prescriptions criticised

Prescribing gluten-free foods for people with coeliac disease is a costly and bureaucratic waste of GPs’ and patient’s time that should be stopped, according to independent prescribing experts.

An editorial in the Drug and Therapeutics Bulletin (DTB) argues that the process of GPs prescribing gluten free foods such as bread and flour is outmoded. It recommends this should be replaced with a system such as vouchers that allows people to buy the products from supermarkets.

According to the bulletin, the NHS prescription scheme for gluten free foods was started in the 1960s when it was difficult for patients to access gluten free foods. However, now that gluten free foods are available in supermarkets, there is no longer a need for the £27m a year system, which requires patients to get prescriptions from the community pharmacy.

The DTB says that with growing pressure on NHS budgets it is right to question this arrangement, and it is also questionable on health grounds whether doctors should be providing prescriptions for gluten free cake mixes and sweet biscuits.

Coeliac disease patients deserve support for obtaining gluten free foods, which can cost up to 500% more than gluten-containing equivalents, but this can be done without having to go through the GP or pharmacy, the Bulletin editorial says.

‘Is it time to consider the use of food vouchers that could be redeemed against gluten-free foods at any outlet, or the provision of personalised budgets for people with coeliac disease, so that the supply of food would no longer be a medical issue?,’ the editorial asks.

‘We would urge commissioners to consider redesigning services to ensure that there is ongoing support for people with coeliac disease and to remove the bureaucratic process of prescribing food from primary care.’

Readers' comments (6)

  • I've always thought this is a crazy situation - if a patient is allergic to nuts we don't prescribe an alternative although there is not inconsiderable cost in time, effort and money involved in avoiding these, the consequences are potentially much more serious too. There are numerous conditions/diseases that have a financial cost which the NHS doesn't pay for so why this? Gluten free has to be one of the easiest of the 'avoidance' diets with supermarkets having huge ranges available - times have changed and so should the NHS - whist we are at it why not revisit free prescription and travel vaccine categories too!

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  • Thus speaks someone who knows very little other than the basics and has no concept whatsoever how difficult it can be for the true coeliac to adhere to a strict gluten free diet .

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  • In our PCT my coeliac teenage son receives a total of 8 small loaves of bread on prescription per month. I still spend around £80 per month on glutenfree pasta, extra bread (small genius loaves are £2.99), flour mix for home baking and some treats like cake and frozen pizza. It is not an inconsiderable amount of money for families on tight budgets, and small fry compared with the cost of many medications.

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  • I sympathise with both respondents; the "medical" value is in having established the diagnosis. The issue of medical staff altering whether it is white , brown, refined unrefined , loave, part baked, or ready baked, "get a new prescription because the manufactrer has changed the size from 400g to 375g, " from chemists with the " I won't order it unless you prescribe in packs of 8 otherwise I get left with stock that expires" and so on is clearly dissatisfying for all parties and infuriating to the patient.
    It does need to be sorted.
    A certificate of confirmation and some designated pickup /voucher scheme is long overdue.

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  • I believe it was correct to prescribe Gluten free staple many years ago, when that was truly a ‘prescription’ item. Many years on, due to lifestyle changes, this has become the ‘new staple’ and available from most, if not all supermarkets for the price of a non-gluten staples. As such it should NOT be under any circumstances prescribed on the NHS. I have been harping on about this for 10+ years, but no one wishes to be the first. At least some places no longer prescribe biscuits, as this too was OK to do.

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  • I wonder how many of the above authors would change their opinions if they were diagnosed with coeliac tomorrow. Nobody chooses to be coeliac and the sickness it causes to go with it. Living life as a coeliac is extremely difficult. Please do not kick us when we are already down.

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